1/1500. Z-plasty closure of the donor defect of the radial forearm free flap.

The radial forearm is a popular free flap site for reconstruction of head and neck defects, because of its abundant, pliable, skin component and an available, extended, vascular pedicle. In addition, vascularized composite flaps, including a segment of radius, can be designed for skeletal stabilization. The donor-site defect can involve various complications, including loss of skin graft, unsatisfactory appearance, numbness, and radial fracture. Recent advances in reducing donor-site defect problems have included the use of rotationskin flaps, local muscle rotation, and soft-tissue expansion; however, each of these has its own limitations. Two cases are presented in which radial forearm donor site defects, measuring less than 4 cm x6 cm, were primarily closed successfully with z-plasties based on the longitudinal skin incision. Each patient has regained preoperative mobility, and prompt primary healing was achieved without complications. ( info)

We have applied conventional histochemical, immunocytochemical and morphometric techniques to study the changes within the human spinal sympathetic preganglionic neurons (SPNs) after spinal cord injury. SPNs are localized within the intermediolateral nucleus (IML) of the lateral horn at the thoraco-lumbar level of the spinal cord and are the major contributors to central cardiovascular control. SPNs in different thoracic segments in the normal spinal cord were similar in soma size. SPNs in the IML were also identified using immunoreactivity to choline acetyltransferase. Soma area of SPNs was 400.7 15 microm2 and 409.9 /-22 microm2 at the upper thoracic (T3) and middle thoracic (T7) segments, respectively. In the spinal cord obtained from a person who survived for 2 weeks following a spinal cord injury at T5, we found a significant decrease in soma area of the SPNs in the segments below the site of injury: soma area of SPNs at T8 was 272.9 /-11 microm2. At T1 the soma area was 418 /-19 microm2. In the spinal cord obtained from a person who survived 23 years after cord injury at T3, the soma area of SPNs above (T1) and below (T7) the site of injury was similar (416.2 /-19 and 425.0 /-20 microm2 respectively). The findings demonstrate that the SPNs in spinal segments caudal to the level of the lesion undergo a significant decrease of their size 2 weeks after spinal cord injury resulting in complete transection of the spinal cord. The impaired cardiovascular control after spinal cord injury may be accounted for, in part, by the described changes of the SPNs. The SPNs in spinal segments caudal to the injury were of normal size in the case studied 23 years after the injury, suggesting that the atrophy observed at 2 weeks is transient. More studies are necessary to establish the precise time course of these morphological changes in the spinal preganglionic neurons. ( info)

Some missile injuries are reviewed after nearly 8 years of continuous warfare. A feature of many of these injuries is the early admission to hospital which has had a profound effect on the survival rate and the recovery period. Some examples are given of injuries inflicted by rubber bullets. The effects of wounding by low and high velocity missiles are described and examples given. An injury caused by a missile incorporated in a bomb is also shown. ( info)

4/1500. Pellet embolization to the right atrium following double shotgun injury.

A 28-year-old man sustained two shotgun injuries of the left inguinal region from a distance of about 1.5 m by simultaneous discharge of both shells from a sawn-off double-barrelled 16-bore shotgun (diameter of the lead pellets, 4 mm). The first X-ray examination carried out soon after hospital admission showed a single embolized pellet near the right margin of the cardiac silhouette. Eight months later, the man committed suicide by drug intoxication. At autopsy, the embolized pellet was found embedded between the pectinate muscles of the right atrium. On the basis of the reported case and with reference to the pertinent literature, the paper points out the medico-legal aspects of venous bullet/pellet embolism and the risk of lead poisoning after shotgun injury. ( info)

5/1500. Lead toxicity from gunshot wound.

Lead toxicity from gunshot wound is a rare complication. It occurs when body fluids, especially synovial cavity fluids, dissolve lead from the bullets, resulting in absorption and toxicity. Metabolic stress, infection, or alcoholism can also enhance absorption. Combination of chelation and surgical removal can result in favorable prognosis. awareness of this condition allows appropriate diagnostic and therapeutic interventions to be initiated in a timely manner. ( info)

6/1500. Iliac to popliteal artery bypass through the iliac wing: An alternative extracavitary route for management of complex groin injuries.

Extracavitary bypass through the iliac wing allows placement of the grafts into the posterior thigh and is another alternative route when an obturator bypass is not possible, or an axillary-popliteal bypass is to be avoided. The transiliac wing bypass is relatively simple and easy to perform. The bypass route is short and direct, has excellent inflow, and is accompanied by minimal neurological or bleeding risks. An illustrative case is presented with a complete description of the operative technique. review of the literature is also included. ( info)

Thoracic trauma occurs frequently but seldom requires surgery (10-20%, [1]). The mortality rate for gunshot wound of the chest varies from 14.3 to 36.8% [2]. We report, herein an example of bullet injury to the pulmonary artery (PA) following a thoracic gunshot wound. This patient had previous history of coronary surgery. Absolute and relative indications for exploratory thoracotomy in emergency will be reviewed. ( info)

Penetrating cardiac trauma can result in a wide range of injuries to intracardiac structures. Missile injury, in particular, can cause damage in more than one cardiac chamber that may be difficult to identify at initial emergent operation. We report a case of late repair of traumatic ventricular septal defect and tricuspid valve perforation from gunshot wound. This case illustrates the importance of thorough examination of intracardiac anatomy during emergent and delayed repair for penetrating cardiac trauma. ( info)

A 22-year-old man suffering from isolated erectile dysfunction associated with damage to the right spinal nerve S2 caused by sacral gun-shot injury. He has no loss of bladder innervation. Treatment has been implantation of a penile prosthesis. ( info)

10/1500. pressure-controlled inverse-ratio synchronised independent lungventilation for a blast wound to the chest.

Massive unilateral pulmonary injury poses a severe ventilatory problem. We used pressure-controlled, inverse-ratio, independent lungventilation for a shotgun injury. Two synchronised Siemens Servo 900C ventilators were connected to a double lumen endotracheal tube. Arterial pO2 tripled in 15 minutes, and the patient remained on SILV for 36 hours. ( info)